Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study

doi:10.2147/CLEP.S245817

. 2020 Jun 16:12:617-624.

doi: 10.2147/CLEP.S245817. eCollection 2020.

Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study

Sheng-Feng Sung^#¹, Chien-Chou Su^#^{2

3

4}, Cheng-Yang Hsieh^{2

3

5}, Ching-Lan Cheng^{2

3

4

6}, Chih-Hung Chen⁷, Huey-Juan Lin⁸, Yu-Wei Chen^{9

10}, Yea-Huei Kao Yang^{2

3

4

6}

Affiliations

¹ Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
² Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
⁶ School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Neurology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan.
⁸ Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.
⁹ Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan.
¹⁰ Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.

^# Contributed equally.

PMID: 32606987
PMCID: PMC7305833
DOI: 10.2147/CLEP.S245817

Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study

Sheng-Feng Sung et al. Clin Epidemiol. 2020.

. 2020 Jun 16:12:617-624.

doi: 10.2147/CLEP.S245817. eCollection 2020.

Authors

Sheng-Feng Sung^#¹, Chien-Chou Su^#^{2

3

4}, Cheng-Yang Hsieh^{2

3

5}, Ching-Lan Cheng^{2

3

4

6}, Chih-Hung Chen⁷, Huey-Juan Lin⁸, Yu-Wei Chen^{9

10}, Yea-Huei Kao Yang^{2

3

4

6}

Affiliations

¹ Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
² Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
⁶ School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Neurology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan.
⁸ Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.
⁹ Department of Neurology, Landseed International Hospital, Taoyuan, Taiwan.
¹⁰ Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.

^# Contributed equally.

PMID: 32606987
PMCID: PMC7305833
DOI: 10.2147/CLEP.S245817

Abstract

Purpose: Home-time has been found to correlate well with modified Rankin Scale (mRS) scores in patients with stroke. This study aimed to determine its correlations in patients with different types of stroke at various time points after stroke in a non-Western population.

Methods: This study used linked data from multi-center stroke registry databases and a nationwide claims database of health insurance. Functional outcomes as measured with the modified Rankin Scale were obtained from the registry databases and home-time was derived from the claims database. Spearman correlation coefficients were used to assess the correlation between home-time and mRS scores. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of home-time in predicting good functional outcome.

Results: This study included 7959 patients hospitalized for stroke or transient ischemic attack (TIA), for whom mRS scores were available in 6809, 6694, and 4330 patients at 90, 180, and 365 days, respectively. Home-time was highly correlated with mRS scores at the three time-points in patients with ischemic (Spearman's rho -0.69 to -0.83) or hemorrhagic (Spearman's rho -0.86 to -0.88) stroke, but the correlation was only weak to moderate in those with TIA (Spearman's rho -0.32 to -0.58). Home-time predicted good functional outcome with excellent discrimination in patients with ischemic (AUCs >0.8) or hemorrhagic (AUCs >0.9) stroke but less so in those with TIA (AUCs >0.7).

Conclusion: Home-time was highly correlated with mRS scores and showed excellent discrimination in predicting good functional outcome in patients with ischemic or hemorrhagic stroke. Home-time could serve as a valid surrogate measure for functional outcome after stroke.

Keywords: disability; home-time; stroke.

PubMed Disclaimer

Conflict of interest statement

The authors declare they have no conflicts of interest with respect to this research study.

Figures

**Figure 1**
The assembly of the study population. **Abbreviations:** mRS, modified Rankin Scale; NHID, National Health Insurance Research Database; TIA, transient ischemic attack.

**Figure 2**
The scheme illustrating the calculation of home-time (days).

**Figure 3**
Box-and-whisker plots showing the distribution of home-times across mRS scores at 90, 180, and 365 days in all patients and subgroups of patients. **Abbreviations:** mRS, modified Rankin Scale; TIA, transient ischemic attack.

See this image and copyright information in PMC

Cited by

Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home.
Louie DR, Simpson LA, Mortenson WB, Field TS, Yao J, Eng JJ. Louie DR, et al. Phys Ther. 2022 Jan 1;102(1):pzab246. doi: 10.1093/ptj/pzab246. Phys Ther. 2022. PMID: 34718796 Free PMC article.
Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.
Anand A, Cheng M, Ibitoye T, Maclullich AMJ, Vardy ERLC. Anand A, et al. Age Ageing. 2022 Mar 1;51(3):afac051. doi: 10.1093/ageing/afac051. Age Ageing. 2022. PMID: 35292792 Free PMC article.
The Allure of Big Data to Improve Stroke Outcomes: Review of Current Literature.
Olaiya MT, Sodhi-Berry N, Dalli LL, Bam K, Thrift AG, Katzenellenbogen JM, Nedkoff L, Kim J, Kilkenny MF. Olaiya MT, et al. Curr Neurol Neurosci Rep. 2022 Mar;22(3):151-160. doi: 10.1007/s11910-022-01180-z. Epub 2022 Mar 11. Curr Neurol Neurosci Rep. 2022. PMID: 35274192 Free PMC article. Review.

References

1. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439–448. doi:10.1161/CIRCRESAHA.116.308413 - DOI - PubMed
1. Hsieh CY, Su CC, Shao SC, et al. Taiwan’s National Health Insurance Research database: past and future. Clin Epidemiol. 2019;11:349–358. doi:10.2147/CLEP.S196293 - DOI - PMC - PubMed
1. Ung D, Kim J, Thrift AG, et al. Promising use of big data to increase the efficiency and comprehensiveness of stroke outcomes research. Stroke. 2019;50(5):1302–1309. doi:10.1161/STROKEAHA.118.020372 - DOI - PubMed
1. Hsieh CY, Wu DP, Sung SF. Registry-based stroke research in Taiwan: past and future. Epidemiol Health. 2018;40:e2018004. doi:10.4178/epih.e2018004 - DOI - PMC - PubMed
1. Hannah D, Lindholm B, Maisch L. Certain uncertainty: life after stroke from the patient’s perspective. Circ Cardiovasc Qual Outcomes. 2014;7(6):968–969. doi:10.1161/CIRCOUTCOMES.114.001315 - DOI - PubMed

LinkOut - more resources

Full Text Sources

[1] Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439–448. doi:10.1161/CIRCRESAHA.116.308413 - DOI - PubMed

[2] Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439–448. doi:10.1161/CIRCRESAHA.116.308413 - DOI - PubMed

[3] Hsieh CY, Su CC, Shao SC, et al. Taiwan’s National Health Insurance Research database: past and future. Clin Epidemiol. 2019;11:349–358. doi:10.2147/CLEP.S196293 - DOI - PMC - PubMed

[4] Hsieh CY, Su CC, Shao SC, et al. Taiwan’s National Health Insurance Research database: past and future. Clin Epidemiol. 2019;11:349–358. doi:10.2147/CLEP.S196293 - DOI - PMC - PubMed

[5] Ung D, Kim J, Thrift AG, et al. Promising use of big data to increase the efficiency and comprehensiveness of stroke outcomes research. Stroke. 2019;50(5):1302–1309. doi:10.1161/STROKEAHA.118.020372 - DOI - PubMed

[6] Ung D, Kim J, Thrift AG, et al. Promising use of big data to increase the efficiency and comprehensiveness of stroke outcomes research. Stroke. 2019;50(5):1302–1309. doi:10.1161/STROKEAHA.118.020372 - DOI - PubMed

[7] Hsieh CY, Wu DP, Sung SF. Registry-based stroke research in Taiwan: past and future. Epidemiol Health. 2018;40:e2018004. doi:10.4178/epih.e2018004 - DOI - PMC - PubMed

[8] Hsieh CY, Wu DP, Sung SF. Registry-based stroke research in Taiwan: past and future. Epidemiol Health. 2018;40:e2018004. doi:10.4178/epih.e2018004 - DOI - PMC - PubMed

[9] Hannah D, Lindholm B, Maisch L. Certain uncertainty: life after stroke from the patient’s perspective. Circ Cardiovasc Qual Outcomes. 2014;7(6):968–969. doi:10.1161/CIRCOUTCOMES.114.001315 - DOI - PubMed

[10] Hannah D, Lindholm B, Maisch L. Certain uncertainty: life after stroke from the patient’s perspective. Circ Cardiovasc Qual Outcomes. 2014;7(6):968–969. doi:10.1161/CIRCOUTCOMES.114.001315 - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study

Affiliations

Home-Time as a Surrogate Measure for Functional Outcome After Stroke: A Validation Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

LinkOut - more resources

Full Text Sources